We use them to cure infectious diseases,

我們用它們來治療感染性疾病，

but also to safely facilitate everything from surgery to chemotherapy

也用於確保手術、化療

to organ transplants.

或是器官移植等過程順利

Without antibiotics,

如果沒有抗生素，

even routine medical procedures can lead to life-threatening infections.

連日常醫療程序都能導致致命的感染

And we’re at risk of losing them.

但我們正面臨著失去抗生素的危機

Antibiotics are chemicals that prevent the growth of bacteria.

抗生素是一種能抑制細菌生長的化學物質

Unfortunately, some bacteria have become resistant

不幸的是，有些細菌演變成對現今所有抗生素

to all currently available antibiotics.

都具有抵抗力

At the same time, we’ve stopped discovering new ones.

在此同時，我們也停止繼續尋找新的抗生素

Still, there’s hope that we can get ahead of the problem.

但是我們仍有希望解決這個問題

But first, how did we get into this situation?

不過首先，目前這個狀況是麼發生的?

The first widely used antibiotic was penicillin,

第一個被廣泛使用的抗生素是青黴素 (盤尼西林)，

discovered in 1928 by Alexander Fleming.

在 1928 年被亞歷山大·弗萊明發現

In his 1945 Nobel Prize acceptance speech,

在1945年諾貝爾獎的獲獎演說中，

Fleming warned that bacterial resistance had the potential to ruin

弗萊明警告大眾，細菌的抗藥性有可能會毀掉

the miracle of antibiotics.

抗生素的神奇療效

He was right: in the 1940s and 50s,

他說的沒錯 : 在 1940 到 50 年代，

resistant bacteria already began to appear.

具有抗藥性的細菌就已經開始出現了

From then until the 1980s,

直到 1980 年代，

pharmaceutical companies countered the problem of resistance

製藥公司試著反制抗藥性的問題

by discovering many new antibiotics.

藉由尋找更多新的抗生素

At first this was a highly successful— and highly profitable— enterprise.

一開始這是一門非常成功，而且很賺錢的事業

Over time, a couple things changed.

隨著時光流逝，有些事情改變了

Newly discovered antibiotics were often only effective

新發現的抗生素通常

for a narrow spectrum of infections,

只能抑制有限種類的細菌感染，

whereas the first ones had been broadly applicable.

而青黴素卻能被廣泛使用

This isn’t a problem in itself,

這並不表示這些抗生素沒有效

but it does mean that fewer doses of these drugs could be sold—

但卻意味著它們沒辦法大賣

making them less profitable.

導致生產這些抗生素無利可圖

In the early days, antibiotics were heavily overprescribed,

在早期，抗生素被過分地濫用

including for viral infections they had no effect on.

就算是抗生素無效的病毒性感染也一樣

Scrutiny around prescriptions increased, which is good, but also lowered sales.

近期對於開處方簽變得更加謹慎了，這是件好事，但同樣會導致銷售額下降

At the same time, companies began to develop more drugs

在此同時，廠商也開始研發更多

that are taken over a patient’s lifetime,

慢性病的藥物

like blood pressure and cholesterol medications,

像是降血壓或是膽固醇

and later anti-depressants and anti-anxiety medications.

接著是抗憂鬱以及抗焦慮藥

Because they are taken indefinitely, these drugs more profitable.

由於患者必須長期服用，這些藥物顯得更有賺頭

By the mid-1980s, no new chemical classes of antibiotics were discovered.

到了1980年代中期，沒有任何一種新化學分類的抗生素被發現

But bacteria continued to acquire resistance and pass it along

而細菌卻持續獲得抗藥性，甚至還把它傳遞出去

by sharing genetic information between individual bacteria

藉由在細菌個體之間分享遺傳資訊

and even across species.

甚是在不同種的細菌之間

Now bacteria that are resistant to many antibiotics are common,

現今對許多抗生素都具有抗藥性的細菌並不少見，

and increasingly some strains are resistant to all our current drugs.

有些菌種甚至對所有我們已知的藥物都有抗藥性

So, what can we do about this?

所以，我們到底該怎麼做?

We need to control the use of existing antibiotics, create new ones,

我們必須克制使用現有的抗生素，並製造新的抗生素

combat resistance to new and existing drugs,

使用新的及現有的藥物對抗細菌抗藥性，

and find new ways to fight bacterial infections.

此外找尋新的對抗細菌感染的方法

The largest consumer of antibiotics is agriculture,

抗生素的最大客戶就是農業，

which uses antibiotics not only to treat infections

他們不只使用抗生素來防止感染

but to promote the growth of food animals.

還用來促進食用動物的成長

Using large volumes of antibiotics

若是使用大量的抗生素

increases the bacteria’s exposure to the antibiotics

將會使細菌有機會接觸更多抗生素

and therefore their opportunity to develop resistance.

讓它們更有可能發展出抗藥性

Many bacteria that are common in animals, like salmonella, can also infect humans,

許多在動物中常見的細菌，像是沙門氏桿菌，也能感染人類

and drug-resistant versions can pass to us through the food chain

而具有抗藥性的沙門氏桿菌能藉由食物鏈傳染給我們

and spread through international trade and travel networks.

然後經由國際貿易和旅遊網路散播出去

In terms of finding new antibiotics,

說到尋找新的抗生素，

nature offers the most promising new compounds.

大自然提供給我們相當值得期待的新化合物

Organisms like other microbes and fungi have evolved over millions of years

微生物和真菌等生物經過數百萬年的演化

to live in competitive environments—

為了能在充滿競爭的環境中存活

meaning they often contain antibiotic compounds

這表示它們通常擁有一些抗菌化合物

to give them a survival advantage over certain bacteria.

幫助它們在面對特定細菌時更有生存優勢

We can also package antibiotics with molecules that inhibit resistance.

我們也能使用一些抑制細菌抗藥性的分子來包裹住抗生素

One way bacteria develop resistance is through proteins of their own

細菌發展出抗生素的其中一個方式就是利用自身的蛋白質

that degrade the drug.

來分解藥物

By packaging the antibiotic with molecules that block the degraders,

藉由抗生素周圍的分子保護它不被分解

the antibiotic can do its job.

讓抗生素能完成任務

Phages, viruses that attack bacteria but don’t affect humans,

噬菌體，一種會攻擊細菌卻不會感染人類的病毒

are one promising new avenue to combat bacterial infections.

是一條新的通往對抗細菌感染的康莊大道

Developing vaccines for common infections, meanwhile,

與此同時，研發一般感染症的疫苗

can help prevent disease in the first place.

能幫助我們事先預防疾病

The biggest challenge to all these approaches is funding,

以上方法的最大挑戰就是資金

which is woefully inadequate across the globe.

而全球疫苗研發的經費嚴重缺乏

Antibiotics are so unprofitable that many large pharmaceutical companies

製造抗生素無利可圖

have stopped trying to develop them.

造成許多大型藥廠已經停止研發

Meanwhile, smaller companies that successfully bring new antibiotics

同時，成功研發出新抗生素的小型藥廠

to market often still go bankrupt, like the American start up Achaogen.

卻仍然免不了破產，像是美國新創公司 Achaogen

New therapeutic techniques like phages and vaccines

嶄新的治療法，例如嗜菌體和疫苗

face the same fundamental problem as traditional antibiotics:

與傳統的抗生素療法一樣需要面對資金問題

if they’re working well, they’re used just once,

若它們非常具有療效，就只需要使用一次

which makes it difficult to make money.

使它們很難用來賺錢

And to successfully counteract resistance in the long term,

為了能長時間抵銷抗藥性

we’ll need to use new antibiotics sparingly—

我們必須要節制地使用新抗生素

lowering the profits for their creators even further.

盡可能降低創造者的獲益

One possible solution is to shift profits away from the volume of antibiotics sold.

其中一個解決辦法就是將抗生素的售出量與獲利脫鉤

For example, the United Kingdom is testing a model

舉例來說，英國正在測試一個新模式

where healthcare providers purchase antibiotic subscriptions.

醫療保健人員以訂閱制的方式購買抗生素

While governments are looking for ways to incentivize antibiotic development,

而同時間政府則尋找方法來鼓勵抗生素研發

these programs are still in the early stages.

這些企劃目前還在初期階段

Countries around the world will need to do much more—

世界各國需要做的事情還有很多

but with enough investment in antibiotic development

但只要抗生素研發的投資足夠

and controlled use of our current drugs,

以及控制現有藥物的使用量

we can still get ahead of resistance.

我們依然能解決病原抗藥性